神经内镜下显微血管减压术治疗三叉神经痛和面肌痉挛  

Fully neuroendoscopic microvascular decompression for the treatment of trigeminal neuralgia and hemifacial spasm

作　　者：林晓宁[1] 张峰林[1] 田新华[1] 李泉清[1] 魏峰[1] 黄延林[1] 杨芳裕[1] 孙瑾[1] 黄志纯[1] 

机构地区：[1]厦门大学附属中山医院神经外科,361004

出　　处：《中华神经外科杂志》2017年第10期996-999,共4页Chinese Journal of Neurosurgery

摘　　要：目的 观察完全神经内镜下显微血管减压术（MVD）治疗三叉神经痛和面肌痉挛的安全性和疗效.方法 纳入厦门大学附属中山医院神经外科2014年11月至2016年6月采用完全神经内镜下完成MVD的患者32例,其中原发性三叉神经痛（TN）11例,面肌痉挛（HFS）21例.回顾性分析手术的安全性和疗效.结果 术中32例均在内镜下发现责任血管,其中单纯动脉压迫者28例,单纯静脉压迫者1例,动静脉同时压迫者3例.11例TN患者,术后10例疼痛消失,1例疼痛减轻;2例出现面部麻木感.21例HFS患者,依据Shorr分级,20例术后症状完全缓解,其中19例由术前的Ⅱ、Ⅲ级恢复为0级,1例由Ⅲ级恢复为Ⅰ级;1例部分缓解,Shorr分级由术前的Ⅳ级恢复至Ⅱ级.术后岩静脉均保留,无一例出现严重脑出血、脑损伤、严重颅内感染等并发症.1例出现听力下降,1例出现轻度面瘫.随访6 ～24个月,平均（10.0±2.3）个月,所有患者术后症状均无复发或加重.结论 完全神经内镜下MVD治疗TN和HFS,术中细微血管结构显示清晰,可避免遗漏责任血管,对脑组织牵拉小,是一种安全、有效的手术方式.Objective To explore the safety and efficacy of the treatment of trigeminal neuralgia and hemifacial spasm via fully neuroendoscopic microvascular decompression （MVD）.Metlods The clinical data of 32 patients underwent fully neurcendoscopic MVD during the period from November 2014 to June 2016 and were enrolled into this retrospective study.Among them,11 cases were trigeminal neuralgia （TN） and 21 cases were hemifacial spasm （HFS）.Results The offending vessels were identified under endoscope in all cases.Among them,arterial compression was found in 28 cases,venous compression in 1 case,and both arterial and venous compression in 3 cases.In all 11 cases of trigeminal neuralgia,the symptom disappeared in 10 cases and was relieved in 1 case post surgery.Facial numbness occurred in 2 cases.In all 21 cases of hemifacial spasm,20 cases obtained complete symptomatic relief and 1 case gained partial relief postoperatively.There was 1 case of hearing impairment and 1 case of mild facial paralysis reported post operation.No severe complications or death occurred.All cases were followed up for 6-24 months with a median period of 10.0 ＆#177; 2.3 months.During the follow-up periods,none of the cases reported recurrence or aggravation.Conclusion Fully neurcendoscopic MVD,applied to treatment of TN and HFS,could help facilitate clear exposure of small vessels,avoid missing the offending vessels and reduce retraction of the cerebellum.Fully endoscopic MVD seems to be a safe and effective procedure and warrants further study and exploration.

关 键 词：显微血管减压术 神经内镜 神经外科手术 三叉神经痛 面部单侧痉挛 

分 类 号：R651.3[医药卫生—外科学]